Medical-Surgical Nursing: An
Integrated Approach, 2E
Chapter 27
NURSING CARE OF
THE CLIENT:
ENDOCRINE SYSTEM
A Unique System
The endocrine system is unique in that
the components are not in direct physical
contact but are scattered throughout the
body.
 Like the nervous system, it provides
communication and control, but is slower
and has longer lasting control, which it
exerts through the secretion of hormones.

Hormones
Chemical substances that initiate or
regulate activity of another organ, system,
or gland in another part of the body.
 The level of hormone in the blood is
regulated by the homeostasis mechanism
known as negative feedback.

The Glands of the Endocrine
System
The pancreas.
 The pituitary gland.
 The hypothalamus.
 The thyroid.
 The parathyroid.
 The adrenals.

The Pancreas
Raises blood glucose.
 Lowers blood glucose.
 Inhibits secretion of insulin, glucagon, and
growth hormone.

Antherior Pituitary
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Stimulates thyroid growth and secretion of the
thyroid hormone.
Stimulates adrenal cortex growth and secretion
of glucocorticoids.
Stimulates growth.
Stimulates breast development during
pregnancy and milk secretion.
Causes increase in synthesis and spread of
melanin (pigment) in skin.
Stimulates estrogen production; causes
ovulation; stimulates progesterone and
testosterone.
Posterior Pituitary
Stimulates water retention by kidneys to
decrease urine secretion.
 Stimulates uterine contractions; causes
breast to release milk into ducts.
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Thyroid Gland
Increases metabolic rate.
 Decreases blood calcium concentration.

Parathyroid Gland
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Increases blood calcium concentration.
Adrenal Cortex
Stimulates gluconeogenesis and
increases blood glucose;
antiinflammatory; antiimmunity;
antiallergy.
 Regulates electrolyte and fluid
homeostasis.
 Stimulates sexual drive in females; in
males, negligible effect.

Adrenal Medulla
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Prolongs and intensifies sympathetic
nervous response to stress.
Assessment
Assessment of the endocrine system can
be challenging since the glands are
scattered.
 Negative findings are as important as
positive findings.
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Diabetes Mellitus
A disorder of metabolism which affects
the production and secretion of insulin.
 Insulin is a hormone produced and
secreted by beta cells in the islets of
Langerhans in the pancreas. It stimulates
the active transport of glucose into muscle
and adipose tissue cells, making it
available for cell use.

How Insulin Works
When we eat, food is broken down into
chemicals and glucose enters bloodstream.
In response to elevated serum glucose, beta cells
of pancreas secrete insulin into bloodstream.
Insulin combines with insulin receptors on cell
wall (activating glucose transporters) allowing
glucose to enter cell.
Hyperglycemia/Hypoglycemia
A deficiency of insulin results in
hyperglycemia (elevated blood glucose).
 An excess of insulin results in
hypoglycemia (low blood glucose).
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At-Risk for Diabetes
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Anyone age 45 and older.
Anyone, regardless of age, with one of the
following risk factors: Obesity; immediate family
member with diabetes; member of high-risk
ethnic group (African-American, HispanicAmerican, some Native American groups)/
Having a baby weighing more than 9 pounds.
History of gestational diabetes mellitus.
Hypertension.
High-density lipoprotein level of 35 mg/dL or
less, or a triglyceride level of 250 mg/dL or
more.
Diabetic Control
A coordinated program of exercise, diet,
and medications is used to achieve
diabetic control.
 Persons with type 1 diabetes always
require insulin therapy in addition to
dietary control and exercise. Persons with
type 2 diabetes are managed through diet
and exercise and may or may not require
oral hypoglygemic agents or insulin.
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Five Goals of Nutrition Therapy
to Control Diabetes Mellitus
Maintain as near-normal blood glucose
level.
 Achieve optimal serum lipid levels.
 Provide adequate calories to maintain or
attain a reasonable weight.
 Prevent and treat acute complications of
insulin-treated diabetes.
 Improve overall health through optimal
nutrition.
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Symptoms of Acute Complications of Diabetes:
Hypoglycemia
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Mild Hypoglycemia:
 Diaphoresis.
 Pallor.
 Paresthesias.
 Excess hunger.
 Palpitations.
 Tremors.
 Anxiety.
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Severe Hypoglycemia:
Seizures.
Loss of consciousness.
Shallow respirations.
Moderate
Hypoglycemia:
 Confusion,
disorientation.
 Slurred speech.
 Behavior
changes.
 Irritability.
Nursing Alert!
Severe hypoglycemia
is a medical emergency.
Administer some form of
glucose immediately.
Symptoms of Acute Complications of Diabetes:
Hyperglycemia Hyperosmolar Nonketonic
(HHNK) Syndrome
Polyuria.
 Polydipsia.
 Skin hot, dry, decreased turgor.
 Dehydration—hypotension, increased
pulse.
 Blurred vision.
 Weakness.
 Mental status changes, confusion to
coma.
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Symptoms of Acute Complications of Diabetes:
Diabetic Ketoacidosis (DKA)
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Same as HHNK plus symptoms of
acidosis:
 “Fruity” odor to breath.
 Kussmaul’s respirations (deep,
nonlabored).
Chronic Complications of
Diabetes
Infections (include diabetic foot infections,
boils, cellulitis, urinary tract infections,
yeast infections.
 Diabetic neuropathies.
 Nephropathy (Chronic renal failure).
 Retinopathy.
 Vascular changes.
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Pituitary Disorders
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Hyperpituitarism:
 Gigantism: proportional overgrowth of
all body tissues.
 Acromegaly: bone thickening with
transverse growth and tissue
enlargement.
Pituitary Disorders
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Hypopituitarism: a complex syndrome
marked by metabolic dysfunction, sexual
immaturity, and growth retardation.
 Simmonds’ Disease: total absence of all
pituitary secretions.
 Diabetes insipidus: a deficiency of ADH.
Thyroid Disorders:
Hyperthyroidism
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A collective term for a condition marked
by increased thyroid activity and
overproduction of thyroid hormones
thyroxine and triiodothyronine.
Thyroid Disorders:
Hypothyroidism
A condition in which the metabolic
processes are decreased because of a
deficiency of the thyroid hormone.
 Hypothyroid conditions include cretinism,
myxedema, and Hashimoto’s thyroiditis.
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Goiter
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An enlargement of the thyroid unrelated to
inflammation or neoplasm.
Parathyroid Disorders
Hyperparathyroidism (overactivity).
 Hypoparathyroidism (deficiency of
parathyroid hormone secretion).
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Adrenal Disorders
Cushing’s disease/syndrome (Adrenal
hyperfunction. Characteristic symptoms
are moon-shaped face and buffalo hump).
 Addison’s disease (Adrenal hypofunction.
Characteristic symptom is bronze
coloration of the skin).
 Pheochromocytoma (A rare disease
characterized by paroxysmal or sustained
hypertension due to excessive secretion
of epinephrine or norepinephrine).
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